To describe clinical and imaging features of patients developing recurrence of ocular inflammation following laser photocoagulation done for areas of retinal ischaemia in apparently quiescent eyes.
A retrospective review of 3 cases (2 males and 1 female) seen at a tertiary referral eye centre in North India between June 2021 to March 2022 was performed. Two of these patients had Behcet’s disease (BD) while one had cytomegalovirus retinitis(CMVR) with B cell acute lymphocytic lymphoma. Laser photocoagulation (LP) was performed for areas of retinal capillary non perfusion, following which all the patients developed exacerbation of ocular inflammation. Multimodal imaging comprising fundus photo, fluorescein angiography, autofluorescence and swept source optical coherence tomography was performed for all the cases.
None of the patients had clinically active disease and the decision for LP was made based on FA. Within 24 hours of LP, both the BD patient presented with complaints of diminution of vision(hand movement), one had developed multifocal retinitis and hypopyon while the other presented with hypopyon and severe vitritis. Both the cases were managed with systemic steroids and immunosuppression. Third patient with healed CMVR who had a visual acuity of 6/12 presented with blurring of vision (visual acuity-6/36) and active retinitis at the site of laser marks after a week of undergoing laser photocoagulation and his systemic antiviral had to be restarted after which the retinitis resolved.
Laser Photocoagulation may result in exacerbation of ocular inflammation. It becomes necessary to rule out subclinical inflammation and monitor closely the uveitic eyes before and after laser photocoagulation as there might be need of oral steroids or increasing immunosuppression.